Check your insurance packets for changes this year
Workers who have received their annual enrollment packets for insurance benefits need to pay special attention to the details this year. The first provisions of the nation’s health care law have been enacted and will bring at least slight changes to many plans.
Some consumers who need to be especially alert as the paperwork arrives include: those who use flexible spending accounts for medical expenses, parents of uninsured adult children under age 26, parents of kids with pre-existing conditions and anyone who plans to get preventive care in the coming year.
Everybody needs to pay attention to the costs, because most employees will be asked to pay more for health care next year. Provisions of the health care law taking effect are expected to increase insurance costs by about 1 percent to 2 percent, a portion of an 8.7 percent jump in average premiums expected to hit metro Atlanta's employers next year.
Here’s how the law may change your coverage:
Flexible spending accounts: Workers for years have been able to set aside tax-free dollars in an account that could be used within the year to pay for everything from insurance deductibles and eye surgery to Advil and allergy pills. But starting in 2011, the account may not be used for over-the-counter medicines unless a doctor writes a prescription for it. And by 2013, contributions to the accounts will be limited to $2,500.
Coverage for young adults: Adults younger than 26 will be allowed to stay on their parents' health insurance plan if they are not offered coverage through an employer.
Children with illnesses: Insurers may no longer deny coverage to children under 19 because of a pre-existing condition.
Preventive care coverage: All new plans must pay for mammograms, colonoscopies, immunizations and other preventive services without charging consumers a deductible, co-pay or co-insurance charge.
Lifetime caps: Insurers may no longer impose lifetime dollar limits on essential health care benefits, such as hospital stays. In the past, consumers with catastrophic conditions could exceed the limits of a policy and find themselves responsible for all medical expenses over the policy's limit. Annual dollar limits also will be restricted for all group plans and new plans in the individual market.
Appeals process: Consumers will now have a means to appeal coverage and claims decisions by their insurers.
Canceling coverage: Insurers have been criticized for going back to a consumer's original insurance application to search for errors or technical mistakes and using those as a reason to cancel a policy after someone became ill. The new law will no longer allow this.
New coverage for people with pre-existing conditions: Consumers without coverage for at least six months because of a pre-existing condition are eligible to get insurance through the program. States had the option of running the program themselves or asking the federal government to do it. Georgia and 20 other states opted to have the feds run the program. The program will serve as a bridge to 2014, when discrimination based on pre-existing conditions will be prohibited. The national program began July 1. Go to healthcare.gov for information.
Medicare drug costs: About 4 million seniors who will reach the Medicare "doughnut hole" -- a gap in prescription drug coverage -- will be eligible for a $250 rebate this year. First checks were mailed in June.
Help with early retiree health expenses: Companies and unions that offer retiree health care coverage can receive help paying for those benefits for retirees between 55 and 65. So far, more than two dozen Georgia entities, including some of the state's largest companies, have applied for the assistance.
Doctor access: The new law guarantees that consumers can choose their primary care doctor or pediatrician from the plan's network and that patients can see an ob-gyn doctor without a referral from another doctor. The law also ensures that you can seek emergency care at a hospital outside your plan's network without prior approval from your health plan.
Note about exceptions: Most health plans in place on March 23, when the health care law was enacted, are considered "grandfathered" plans and are not required to comply with some of these provisions. Plans lose their grandfathered status if significant changes are made to them.
What's to come?The most significant changes set forth in the health care law will not take effect until 2014. That's when the controversial requirement that everyone buy health insurance kicks in and when each state oversees a new health insurance marketplace for people who don't get coverage at work. The marketplace is expected to guide consumers to a variety of insurance options ranging from government insurance for the poor, subsidies for private insurance coverage and a range of private insurance options offered under a new set of rules.
About the Author
Carrie Teegardin is a reporter and part of the investigative team at The Atlanta Journal-Constitution. She is a graduate of Duke University and has won numerous national journalism awards.
